How Often Should You Change Your Pillowcase for Acne?

If you have acne-prone skin, change your pillowcase every two to three nights, and every night if you use oily hair products or are breaking out on the side you sleep on. Wash the rest of your sheets at least once a week in hot water. A pillowcase won't cause acne by itself, but oil, hair product and sweat building up on it can make breakouts harder to clear.

Here's where that schedule comes from, what actually collects on a pillowcase, what the evidence says about silk and copper pillowcases, how hair products end up on your face overnight, and what to do about towels and bedding while you're at it.

How often should you change your pillowcase if you have acne?

Every two to three nights is a practical schedule for acne-prone skin, and nightly is reasonable when you're breaking out on one side. It helps to know where that number comes from. The American Academy of Dermatology (AAD) tells people whose acne may come from hair products to wash everything their head touched, including pillowcases and sheets, but it doesn't set a frequency. For sheets in general, Cleveland Clinic dermatologist Sean McGregor says medical experts advise washing your sheets at least once a week. The pillowcase is the one piece of bedding your face presses into for hours, so for acne-prone skin, changing it more often than the sheets is a cheap, low-risk precaution. It's a sensible habit with no clinical trial behind the exact number, and you should treat it that way.

A simple way to make this painless: buy a pack of five to seven inexpensive cotton pillowcases, keep them in the bedside drawer, and swap one in every other night. Flipping the pillowcase over gives you a clean side for one extra night.

What builds up on a pillowcase?

A pillowcase collects what your skin, hair and products leave behind. Cleveland Clinic lists what accumulates on bedding as dust mites, dead skin, sweat and body oils, dirt, bacteria and allergens such as dust and pet dander. Add whatever is on your hair and face at bedtime: conditioner, styling cream, hair oil, night cream, spot treatment.

None of that causes acne directly. Acne starts when hair follicles become blocked with excess oil and dead skin cells, and the NHS lists hormone changes during puberty, periods, menopause and pregnancy among its common triggers. What a dirty pillowcase can do is add oily residue and rub it into skin that is already prone to clogging. Cleveland Clinic's guide to acne locations names dirty makeup brushes, a germ-ridden cell phone or unwashed pillowcases as possible contributors to cheek breakouts. That's a good reason to keep the fabric clean, though clean bedding alone is unlikely to clear acne.

Does sleeping on one side cause acne on that side?

It can make breakouts on that side worse, through the same mix of pressure, heat and friction that causes acne mechanica. The AAD describes that type of acne as forming when equipment or clothing traps heat and sweat on your skin and then rubs against it. A cheek pressed into a pillow for seven hours is a milder version of the same thing. If your breakouts cluster on the cheek, jaw or temple you sleep on, try these:

• Switch sides, or start the night on your back, for a few weeks and see if the pattern shifts.
• Change the pillowcase on your sleeping side nightly, or use the flip trick.
• Apply moisturizer and treatments early enough that they've absorbed before your face hits the pillow.
• Tie long hair up and away from your face for sleep.

Phones cause a similar one-sided pattern during the day. If the breakouts sit where you hold your phone, read whether your phone is causing the acne on your cheek. Friction from helmets, straps and hats is covered in our guide to acne mechanica.

Do hair products on your pillowcase cause breakouts?

They can, especially along the forehead, hairline, temples and the cheek you sleep on. The AAD says that if you use a hairstyling product that contains a lot of oil, such as a pomade, that's likely the culprit, and that clear skin means getting rid of the residue from hair products too. DermNet describes this as pomade acne, where greasy hair products lead to follicular plugging and comedones along the hairline.

Overnight, product moves from your hair to the pillowcase and from the pillowcase to your face. To cut that transfer:

1. Keep hair off your face. The AAD advises people with oily hair to shampoo more often and keep their hair away from their face.
2. Choose non-comedogenic hair products, which the AAD recommends for hair care as well as makeup.
3. Apply oils and leave-in products to the lengths of your hair, away from the roots and hairline, and give them time to dry before bed.
4. Change the pillowcase more often on nights after heavy styling or a hair-oil treatment.

Are silk pillowcases better for acne?

There's no good evidence that silk pillowcases treat or prevent acne. We couldn't find a published controlled trial showing fewer breakouts on silk, and the AAD, NHS and DermNet acne advice we reviewed for this article doesn't recommend a pillowcase fabric. The marketing claims usually rest on silk causing less friction and absorbing less product than cotton, which is plausible but untested for acne.

What matters more is how clean the pillowcase is. A silk case that gets washed once a fortnight because it's delicate does less for your skin than a cotton case you swap every two nights. If you like silk, use it, but keep the same schedule and follow the care label.

What about copper or "antibacterial" pillowcases?

The evidence for copper pillowcases and acne is thin to absent. Copper-infused pillowcases are mostly marketed for wrinkles and skin "renewal," and we couldn't verify any study showing they reduce acne. Copper's role in skin is real but different: Cleveland Clinic notes that a lack of copper, zinc and iron can play a role in skin diseases like acne, and in the same piece it cautions against reaching for a copper supplement to cure skin concerns. A pillowcase coating is not a treatment. Spend the money on extra cotton pillowcases and a treatment with evidence behind it instead.

Should you use white pillowcases with benzoyl peroxide?

Yes. The AAD warns that benzoyl peroxide will bleach clothing, sheets, pillowcases and towels. If you use a benzoyl peroxide gel at night, switch to white cotton pillowcases that you can wash hot, let the product dry fully before bed, and keep it away from your hairline. Our benzoyl peroxide guide has more on avoiding bleached linens and dryness.

How often should you wash towels and bedding for acne?

Wash bath towels at least once a week, washcloths at least twice a week, and sheets at least weekly. Those are Cleveland Clinic's figures for bath towels and washcloths, and its guide to pillows and upholstery suggests washing pillowcases and bed linens in hot water and with bleach, if possible, weekly. A few acne-specific tweaks:

• Use a clean towel for your face, or a fresh hand towel every couple of days, and pat dry. The AAD advises patting skin dry with a clean towel and warns that roughly rubbing sweat away with a towel can irritate skin and cause breakouts.
• Hang towels flat to dry. Cleveland Clinic advises spreading them on a bar instead of a hook, and washing them two to three times a week in humid conditions.
• Wash pillows themselves every few months, and comforters about every six months, per Cleveland Clinic's bedding guidance.
• Choose a fragrance-free detergent if your skin is also sensitive, and skip heavy fabric softener on pillowcases.
• Take makeup off before bed. The AAD warns that even non-comedogenic makeup can cause acne if you sleep in it.

How can a selfie scan help you see if it's working?

Changing your pillowcase more often is a small habit, and small habits are hard to judge by eye. Taking a selfie under the same light every few days gives you something to compare. An app like Pori returns an overall skin score with a Pores & Texture breakdown, and its before/after comparison lets you put a scan from before your new bedding routine next to one from a few weeks later and see whether the side you sleep on settles down. For setup tips, see our guide to tracking acne progress, and for a full plan, our routine for acne-prone skin.

An app is not a diagnosis, and clean bedding works best alongside an actual acne treatment. The AAD suggests giving any acne treatment at least 4 weeks, and seeing a dermatologist if acne causes cysts or nodules or hasn't cleared with treatment you can buy without a prescription.